Adenomyosis - a disease that many people may not even know about. It is a disease that affects one in 10 women*. Its clinical picture has strong parallels to endometriosis, which many people may be more familiar with. In today's blog post, you can find out all about adenomyosis - from the symptoms to the different types and treatment options. We also explain how adenomyosis can be distinguished from endometriosis.

*In this article, the term "woman" refers to female readers.

How does adenomyosis manifest itself and what exactly does it mean? Adenomyosis describes changes within the uterus in which the lining of the uterus (endometrium) grows into the muscle layer of the uterus (myometrium). This can double or even triple the size of the uterus. Adenomyosis often occurs in women who have given birth more than once and in people who are experiencing the first symptoms of the menopause. It is less common in people under the age of 20.

There are basically two types of adenomyosis, depending on the size and distribution of the adenomyotic lesions. You can find out what these are now.

Focal adenomyosis

This type of adenomyosis is also known as an adenomyoma. It is a benign mixed tumor consisting of glandular and smooth muscle tissue. It occurs within the myometrium, the layer of the uterine wall that consists of smooth muscle.

Diffuse adenomyosis

Diffuse adenomyosis is the most common type of adenomyosis. It develops in a large part of the myometrium and causes the uterus to become greatly enlarged. Depending on where the endometrial tissue is located in the myometrium, a further distinction can be made between superficial and deep adenomyosis.

As with endometriosis, the list of possible symptoms of adenomyosis is quite long. The following symptoms can be associated with the disease:

- Painful (dysmenorrhea) and heavy periods (menorrhagia)
- Pain during or after sexual intercourse (dyspareunia)
- Painful bowel movements
- Infertility

-General exhaustion, tiredness and depression

-Pain in the intestinal area, especially during the period, diarrhea, flatulence

-nerve pain, e.g. in the lower body and legs

If you suspect that you have adenomyosis, you should first discuss your symptoms in detail with your gynecologist. This will make it easier to make a diagnosis.

A vaginal ultrasound must then be performed to diagnose adenomyosis. This will also show whether the uterus is enlarged due to adenomyosis or whether the uterine muscle wall is abnormally shaped. To confirm the diagnosis, a magnetic resonance imaging (MRI ) scan is often performed.

Adenomyosis is a chronic disease of the uterus. Similar to endometriosis, those affected often suffer from severe pain and this disease can also prevent pregnancy and fundamentally restrict the lives of those affected.

Adenomyosis has long been described as a subtype of endometriosis - but this is not entirely correct. Nevertheless, it is not so easy to differentiate between the two gynecological diseases, as many people have both adenomyosis and endometriosis at the same time. It can also be confusing that adenomyosis is often referred to as internal endometriosis in medicine. Would you like to find out more about endometriosis? Then take a look here

You may now be wondering how the two diseases can be differentiated. Just like endometriosis, adenomyosis causes endometrial growths. The difference? In adenomyosis, these growths develop in the muscle layer of the uterine wall (myometrium) and in endometriosis, the tissue forms outside the uterus - for example on the ovaries or in the abdominal cavity.

Both surgical and non-surgical measures can be used to treat adenomyosis. It must first be considered whether the patient wishes to retain the uterus or whether family planning has not yet been completed. You can now find out which treatment methods are available here, for example.

Hysterectomy

Hysterectomy, i.e. the surgical removal of the uterus, is considered the most effective treatment for adenomyosis. However, it is only performed on patients who no longer wish to become pregnant and for whom medical treatment has not had the desired effect. By removing the uterus, the bleeding disappears and the pain improves.

Hormonal treatment

One possible therapy is to supply the body with progestogens in the form of oral contraceptives or the hormonal coil. Treatment with GnRH agonists - a substance that prevents the body from producing sex hormones - is also possible. The substance then ensures that the patient is artificially induced into menopause. This form of therapy can reduce the size of the uterus and reduce the symptoms of adenomyosis. However, if the medication is discontinued, the symptoms usually return after a certain period of time.

Embolization

Embolization involves cutting off the blood supply to the relevant areas of adenomyosis. Embolization is performed by a radiologist who uses a catheter to stop the blood supply to the overgrown areas. The result? The adenomyosis shrinks and the symptoms are reduced or even disappear completely. The blood supply to the uterus remains unaffected.

You may now be wondering what actually triggers adenomyosis. As with endometriosis, the causes of adenomyosis are not yet known. Unfortunately, this disease cannot be prevented. However, there are various theories about the development of adenomyosis.

Studies show, for example, that operations on the uterus pose a risk. It is possible that cells from the uterine lining can enter the muscle layer.

The disease also occurs more frequently in women who have already given birth several times. Inflammatory processes that occur in the period shortly after giving birth could lead to a loosening of cell connections. As a result, cells can become detached from the structure and end up in the wrong layer.

Another possibility is that the disease is congenital or that stem cells from the bone marrow find their way into the uterine muscle via the blood vessels and differentiate into mucosal cells.

Even though this disease can have an effect on fertility, pregnancy is not ruled out. However, if it is not possible to get pregnant naturally, the doctor will advise you of other treatment options. In principle, however, it makes sense to prepare the uterus for fertility treatment in advance, for example through ovarian stimulation.